Optimizing Screening for Tuberculosis and Hepatitis B Prior to Starting Tumor Necrosis Factor-α Inhibitors in Crohn’s Disease

Have, Mike van der; Oldenburg, Bas; Fidder, Herma H.; Belderbos, Tim D.; Siersema, Peter D.; Oijen, Martijn G.H. van

doi:10.1007/s10620-013-2820-9

Cited by 15 publications

(14 citation statements)

References 45 publications

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“…It can be characterized as granulomatous infl ammation with a tendency to necrosis. Patients treated with anti-TNFα have 1.6 to 25.1 times higher risk of tuberculosis as indicated in literature (4,6,12,13,18). The risk of tuberculosis depends on the prevalence of tuberculosis in the region and the type of medicine used.…”

Section: Risk Of Tuberculosis In Biological Therapymentioning

confidence: 90%

Risk of tuberculosis in patients treated with biological medicines

Homolka¹

2016

BLL

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OBJECTIVE: The number of medicines used for biological therapy is constantly increasing. Biologic medicines selectively block the immunological processes leading to autoimmune manifestations with tissue damage or block the progression of haemato-oncological or other malignancies. Biological medicines are usually monoclonal antibodies or inhibitors of certain cytokines, cell receptors and enzymes. Their administration results in immunosuppression associated with increased risk of infectious complications, including tuberculosis. Assessment of the risk of tuberculosis associated with biological medicines is an important part of the medical decision done by pneumologist. We describe the risks of different biologicals and suggest the possible necessary steps in evaluating the risk of tuberculosis in individual patient (Ref.

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Section: Risk Of Tuberculosis In Biological Therapymentioning

confidence: 90%

Risk of tuberculosis in patients treated with biological medicines

Homolka¹

2016

BLL

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“…Van der Have et al [42] compared the conventional approach of TST screening combined with subsequent CXR for exclusion of active TB among TST-positive subjects and an 'extended' strategy in which CXR examination was additionally followed by the QFT. A hypothetical cohort of 30-to 60-year-old patients with inflammatory bowel disease (IBD) was tested prior to administering infliximab, and the outcome (QALYs gained) followed through 3-month Markov cycles over a time horizon of 5 years.…”

Section: Ltbi In Patients With Immunosuppressive Therapymentioning

confidence: 99%

Cost Effectiveness of Preventive Treatment for Tuberculosis in Special High-Risk Populations

2015

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To date, incremental cost-effectiveness analyses on PT in groups at high risk for TB progression, other than contacts, are surprisingly scarce. The variation found between studies likely reflects variations in the major epidemiologic factors, particularly in the estimates on the accuracy of the tuberculin skin test (TST) and interferon-gamma release assays (IGRA) as screening methods used before considering PT. Further research, including explicit evaluation of local epidemiological conditions, test accuracy, and methodology of WTP thresholds, is needed.

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“…The literature on the risk associated with conventional immunosuppressive (thiopurine, methotrexate) or anti-tumor necrosis factor-α (anti-TNF) biologic therapy is more mixed but a majority of data support a modest increase in risk, particularly for opportunistic infections 2, 4–6, 9, 12 . Additionally, agent-specific risks may exist with distinct therapeutic classes such as re-activation of tuberculosis or hepatitis B with anti-TNF therapy 15 .…”

Section: Introductionmentioning

confidence: 99%

Genetic risk factors for serious infections in inflammatory bowel diseases

Sasidharan

Yajnik

Khalili

et al. 2017

Scandinavian Journal of Gastroenterology

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Introduction Immunosuppression, the cornerstone of management of Crohn’s disease (CD) and ulcerative colitis (UC) (inflammatory bowel diseases; IBD) is associated with an increased risk of serious infections that is inadequately predicted by clinical risk factors. The role of genetics in determining susceptibility to infections is unknown. Methods From a prospective consented patient registry, we identified IBD patients with serious infections requiring hospitalization. Analysis was performed to identify IBD-related and non-IBD related immune response loci on the Immunochip that were associated with serious infections and a genetic risk score (GRS) representing the cumulative burden of the identified SNPs was calculated. Multivariable logistic regression used to identify effect of clinical and genetic factors. Results The study included 1,333 IBD patients (795 CD, 538 UC) with median disease duration of 13 years. A total of 133 patients (10%) had a serious infection requiring hospitalization. Patients with infections were more likely to have CD and had shorter disease duration. The most common infections were skin and soft-tissue, respiratory, and urinary tract infections. Eight IBD risk loci and 2 other polymorphisms were significantly associations with serious infections. Each 1 point increase in the infection GRS was associated with a 50% increase in risk of infections (OR 1.53, 95% CI 1.37 – 1.70,) (p=1×10−14), confirmed on multivariable analysis. Genetic risk factors improved performance of a model predicting infections over clinical covariates alone (p < 0.001). Conclusions Genetic risk factors may predict susceptibility to infections in patients with IBD.

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Optimizing Screening for Tuberculosis and Hepatitis B Prior to Starting Tumor Necrosis Factor-α Inhibitors in Crohn’s Disease

Abstract: Extensive TB screening and HBV screening are not cost-effective compared with conventional TB screening and no HBV screening, respectively. However, when targeted at high-risk patient groups, these screening strategies are likely to become cost-effective.

Cited by 15 publications

References 45 publications

Risk of tuberculosis in patients treated with biological medicines

Risk of tuberculosis in patients treated with biological medicines

Cost Effectiveness of Preventive Treatment for Tuberculosis in Special High-Risk Populations

Genetic risk factors for serious infections in inflammatory bowel diseases

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